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Permit (91) CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT IN-I COMMUNITY DEVELOPMENT Permit#: ELR2018-00121 and OR 97223 503.718.2439 13125 SW Hall Blvd.,Ti Date Issued: 08/08/2018 TlCM1-C7 9 Parcel: 2S113AB00500 Jurisdiction: Tigard Site address: 16083 SW UPPER BOONES FERRY RD 300 Project: Therapeutic Associates Subdivision: FANNO CREEK ACRE TRACTS Lot: PT 37 Project Description: Limited energy for fire alarm. Contractor: LAKE ELECTRIC CONTRACTOR INC Owner: G&S FC LLC PO BOX 1550 16083 SW UPPER BOONES FERRY RD, TUALATIN, OR 97062 STE TIGARD, OR 97224 PHONE: 503-234-3044 PHONE: FAX: FEES Description Date Amount Specifics: Restricted Energy Permit 08/08/2018 $75.00 Type of Use: COM 12%State Surcharge-Electrical 08/08/2018 $9.00 Class of Work: ALT Total Number of Systems: 1 • Audio&Stereo: 0 Boiler Controls: 0 CCTV: 0 Clock Systems: 0 Data&Telecommunications: 0 Fire Alarm: 1 HVAC: 0 Instrumentation: 0 Intercom/Paging: 0 Landscape/Irrigation: 0 Landscape Lighting: 0 Medical: 0 Nurse Calls: 0 Protective Signal: 0 Security Alarm: 0 Other: 0 Total $84.00 Other Desc: Required Items and Reports(Conditions) This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issued By: Permittee Signature: OWNER INSTALLATION ONLY The installation is being made on property I own which is not intended for sale,lease or rent. OWNER'S SIGNATURE: Date: CONTRACTOR INSTALLATION ONLY SIGNATURE OF SUPR.ELEC' Date: LICENSE NO. Call 503.639.4175 by 7:00 a.m.for the next available inspection date. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. Electrical Permit Applicatimr1 o R O F F R I: 1 M:O y►.v City of Tigard ReceivedAl ,../. al 11 Permit#:&40R0 /' // 13125 SW Hall Blvd.,Tigard,OR 972AU G C 0l 8 Plan Review ' illi = Phone: 503.718.2439 Fax: 503.598 1960 Related Pe �a„--�>0 Date/B Inspection Line: 503.639.4175 ;I Ready Date/By: Juris: ® See Page 2 for I 11,A11 D Internet: www.ti and-or. ov ° g g s t ... Notified/Method: Supplemental Information TYPE OF WORK PLAN REVIEW D New constructionAddition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked): 0 Service or feeder 400 amps or more 0 Building over three stories. ❑Demolition ❑Other: where the available fault current 0 Marinas and boatyards. CATECIORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings. ❑ 1-and 2-family dwelling Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural amps for all other installations. buildings. 0 Multi-family 0 Master builder 0 Other: 0 Fire pump. 0 Installation of 150 KVA or JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived Job#: r J ❑Addition of new motor load of system. Job site address: C (�0g-1 J� y p .e.,i• S I00HP or more. ❑«A„ «F„ «1 2,> «1 3„ City/State/ZIP: ► 3 O{� (�- i.I2- Y" 0 Six or more residential units. occupancy. I , ' \ ( / ❑Health-care facilities. 0 Recreational vehicle parks. Suite/bldg./apt.#: Project name: /� 0 Hazardous locations. 0 Supply voltage for more than J w�t' 5�� ❑Service or feeder 600 amps or more. 600 volts nominal. Cross street/directions to job site: "17_,-4 J FEE SCHEDULE Description I QtY. I Each I Total I New residential single-or multi-family dwelling unit. Subdivision: Lot#: Includes attached garage. Tax map/parcel#: 1,000 sq.ft.or less 168.54 4 Ea.add'l 500 sq.ft.or portion 33.92 1 DESCRIPTION OF WORK Limited energy,residential P_. 'a I�O r� A''() . Cs(7) A-� ( (with above sq.ft.) 75.00 2 U JJ Limited energy,multi-family M / residential(with above sq.ft.) 75.00 2 0 PROPERTY OWNER 0 TENANT Renewable Energy 0 See Page 2 Services or feeders installation,alteration,and/or relocation Name: 200 amps or less 100.70 2 Address: 201 amps to 400 amps 133.56 2 401 amps to 600 amps 200.34 2 City/State/ZIP: 601 amps to 1,000 amps 301.04 2 Phone:( ) Fax:( ) Over 1,000 amps or volts 552.26 2 Email: Temporary services or feeders installation,alteration,and/or relocation Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 1 intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2 Owner signature: Date: 401 amps to 599 amps 168.54 2 ikAPPLICANT: ❑ CONTACT PERSON Branch circuits—new,alteration,or extension,per panel (� � A.Fee for branch circuits with Business name: f V`^r�- g/� -) r z�Z D,�r —r��..-p 3.:,,s above service or feeder fee, 2 each branch circuit 7.42 2 Contact name: 2 , v l B.Fee for branch circuits without Address: (/�� service or feeder fee,first © `-/�� (-5-50 branch circuit 56.18 2 City/State/ZIP: �( Q c _7 676 -Z Each add'l branch circuit 7.42 2 (l ! Miscellaneous(service or feeder not included) Phone:(5, ) 23Fax: ,� `f-3J y`f ( ) Each manufactured or modular Email: o' � v dwelling,service and/or feeder 67.84 2 ,4,A,/l/' `-r )C( Cot— . Reconnect only 67.84 2 CONTRACTOR Pump or irrigation circle 67.84 2 Business name: v...-e— Sign or outline lighting 67.84 2 Address: Signal circuit(s)or limited-energy panel,alteration,or extension. 0 See Page 2 2 City/State/ZIP: Each additional inspection over allowable in any of t a above Additional inspection(1 hr min) 66.25/hr Phone:( ) Fax: ( ) Investigation(1 hr min) 90.00/hr Email: , (10/1-() 7 bl Industrial plant(1 hr min) 78.18/hr �/1/w Inspections for which no fee is CCB Lic.: 35 --11SCL p r specifically listed(� ) 90.00/hr Electrical Lic.: Su rv.Lic.: 73.} C� p� Y /=hr min Suprv.Electrician Signa•.re,required: 71-2 ( ELECTRICAL PERMIT FEES Subtotal: -- Print name: Si ( 1 Date: E'/.c713( ❑Plan Review Required(25%of permit fee): 1 U I State surcharge(12%of permit fee): Authorized signature: 149/ TOTAL PERMIT FEE: � This permit application expires if a permit is not obtained within 180 L Print name: r' r v Date: g/ /r days after it has been accepted as complete. / * Number of inspections allowed per permit. I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 440-4615T(11/05/COM/WEB Electrical Permit Application—City of Tigard Page 2—Supplemental Information Limited Energy Permit Fees: Renewable Energy Permit Fees: J\ �i.,', ', Y 3 .` .,,:. -h Description ..s.. ,z:. Qty. I Each � Total At A� I Fee for all residential systems combined: $75.00 Renewable electrical energy systems: 5 kva or less 100.70 2 Check Type of Work Involved: 5.01 to 15 kva 133.56 2 ❑ Audio and Stereo Systems* 15.01 to 25 kva 200.34 2 Wind generation systems in excess of 25 kva: Fl B• urglar Alarm 25.01 to 50 kva 301.04 2 50.01 to 100 kva 552.26 2 ❑ Garage Door Opener* >100 kva(fee in accordance 552.26 2 with OAR 918-309-0040) Fl H• eating,Ventilation and Air Conditioning Solar generation systems in excess of 25 kva: System* Each additional kva over 25 7.42 3 ❑ Vacuum Systems* >100 kva—no additional charge 0.0 3 Each additional inspection over allowable in any of the above: ❑ Other: Each additional inspection is 66.25/hr 1 charged at an hourly(1 hr min) Inspections for which no fee is 90.00/hr specifically listed('/hr min) r w �,, � : ' l . ,�%�!*Pig FSEs'" + ' �fl � � � , : Subtotal(Enter on Page 1). Fee for each commercial system: $75.00 * Number of inspections allowed per permit. (SEE OAR 918-309-0000) Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ Boiler Controls ❑ Clock Systems n Data Telecommunication Installation Et Fire Alarm Installation ❑ HVAC ❑ Instrumentation n Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical ❑ Nurse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling ❑ Other: Total number of commercial systems: *No licenses are required. Licenses are required for all other installations I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 16083 SW UPPER BOONES FERRY RD 300, TIGARD, OR, 97224 Record Type: Record ID: Commercial - Electrical Limited Energy ELR2018-00121 Inspection Type: Inspector: 198 Low voltage final Jeff Grove Result: PASS - NoCofO Comments: Violation Summary: Inspector Contractor